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FOR OFFICE USE. <br /> Applicatioq is hereby <br /> made to the San Joaquin Loclalle.HW&District for a permit to construct and install the work herein <br /> described 'This application is <br /> made in compliance th CJunty Ordinance No'. 549 and exi ing Rules'rand Regulations: <br /> Installation will serve: 7-- <br /> Motel <br /> Number of living units----- ------r- Nu ber of gedrooms ---2-�__.Garba_ge Grinder ------------ Lot Size <br /> Water Supply: Public System a 17 1 <br /> Character of soil to a depth of . X <br /> r%l 3 feet: SandL] Silt Clay F1 Peat El Sandy Loam ,[] Clay!Loam 0 <br /> ------------ <br /> (Plot plan, showing siz/of lot, location of system 1n)�e'lation to wells, buildings, etc. must be placed on reverse side.) <br /> eptic tank or seepage pit,permi d if public sewer is available within 200.feet,l <br /> Capacity Type <br /> Distance to-"necrest-tell ---------------------------\------Foundation ---- ----------------- Pro pl. Line ---------------7------ <br /> Ty 16-Filter Mater <br /> ]IZDistad:ce to nearest.. �Well 1----------------------- Foundation,t------------- -__:-Property �Line --------------------- <br /> -------------------- <br /> ----------------- <br /> L f <br /> Disposal Field (Specify Requirements) ----------- <br /> (Draw existing and reqbired raddition on reverse side) <br /> I hereby certify that I have preparedithis application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of Othe Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the folio W*iff9- ---I <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed t " Owner° <br /> Tit I <br /> Title <br /> FOR-DEPARTMENT-USE-ONL-.Y <br /> '� other -4 —'---'---_ . <br /> ' <br /> APPLICATION <br /> � '~ ^' ~ — DATE -­PERMIT |~3U- <br /> ADDITIONAL �^r� — — DATE ._--',___.____ <br /> ____ --- ^' - -- -'-- - --- -- -- -------'''—'----' -� —' - -''------ -'—' ' <br /> Hno| |nspectio" by <br /> ' <br /> --'----'-------'-----��---''�� r—^-'' <br /> -'---_—^-~~~-~-.~_-._-----_---.------------.Do�e -..-�!���)�*~,----- <br /> SAN ]OAQU|N LOCAL HEALTH DISTRICT <br />